Caring for vulnerable populations
	Developing competencies to practice in a managed care environment

	Understanding the influence of poverty, cultural barriers, social support, and personal resources in determining health and illness.
	The role of the physician in multidisciplinary, community-based approaches to preventing illness and treating disease among disadvantaged patients
	Organization and financing of health care as they effect patient outcomes
	Patient-provider communication
	Population-based health care delivery
	Evidence-based health care
	Medical informatics

	The frail elderly
	Low-income mothers and their newborns
	At-risk adolescents and their children

	Clinical rotations that focus on: Home visits Working with social service agencies Community-based health care delivery sites Delivering care to patients as a member of a health care team Designing and implementing population-based health care interventions
	Seminars and small group experiences to develop skills and reinforce key elements of the curriculum, including: Medical interviewing skills Cross-cultural communication Designing population-based health care interventions Case management Monitoring and improving the quality and cost of health care delivery Critical appraisal of the medical literature Computers skills for clinical care

Each of the health care delivery sites and new educational experiences initiated through the Innovations in Graduate Health Professionals Project will remain in place after the grant period. These training programs will provide the basis for expansion of training graduate health professionals to care for vulnerable populations and in managed care contexts in the future.

A total of 10 hours of interactive seminars focussing on the organization and financing of health care, cost containment strategies, quality monitoring and improvement, utilization and referral management, and disease management are being developed jointly by the Departments of Internal Medicine and Pediatrics. These seminars are being given to all residents in these two departments, and will eventually be incorporated into the core lecture series of the Department of Obstetrics and Gynecology.

Resident physicians receive a total of approximately 45 hours of training in critically appraising the medical literature and applying the results to patient care, and in computer skills to facilitate acquisition of medical information.

Resident physicians, nurse midwives, and social workers care for low-income teens and their children in this community-based adolescent health center. Graduate health professionals participate in multidisciplinary management of at-risk teens, innovative community outreach programs for education and identification of health problems, and first-hand exposure to the mission and function of social service agencies such as WIC, MIChild, and the Department of Community Health. The rotations and learners who participate in activities through The Corner are described more fully below.

Resident physicians from Internal Medicine and students from Pharmacy, Social Work, and Advanced Practice Nursing participate in weekly visits to geriatric living centers and the homes of frail elders during a one-month rotation. The purpose of the home visits is to identify, assess, and address issues that affect health. Problems in daily functioning, medication adherence, transportation difficulties, social support, and complications of medical diseases are among the most common difficulties encountered. Intervention strategies are designed and implemented by a multidisciplinary team of health professionals.

During the geriatrics rotation a four-hour seminar series is held each week that complements the community-based training experiences. Topics covered include managed care among the elderly, comprehensive geriatric assessment, evaluation and management of dementia, and the development of combined physician/nursing/social work interventions among the elderly.

Resident physicians participate in state-of-the-art multidisciplinary clinical centers for general geriatrics, dementia, and movement disorders among the elderly.

Pediatrics residents spend full time at The Corner Health Center (described above) delivering care to at-risk adolescents and their children, in community outreach programs to schools, and in community agency visits to organizations providing health care and family support to underserved families.

All Pediatrics interns participate in this month-long rotation in a community-based Pediatrics continuity site focusing on comprehensive care to the children of low-income women. Residents spend time at The Corner Health Center interacting with personnel who support patient care activities and/or provide community outreach – including social workers, the Theater Troupe, and nurses helping patients with insurance eligibility. Residents also spend time at a Coagulation Clinic, a subspecialty hematology clinic that serves as an excellent example of managed care use of subspecialty expertise.

As part of a rotation in Pulmonary Medicine, Allergy, and Immunology, Pediatrics residents participate in asthma primary prevention strategies, including community-based education projects.

Residents assist a visiting nurse on an early-discharge neonatal home visit to gain experience in conducting environmental assessments, as well as educational assessments regarding the needs of newborn infants and their mothers.

Home visits, visits to community social service agencies, and site visits to M-Care management offices are being incorporated into this newly created one-month rotation required rotation. A central component of the rotation is coordination with Pediatrics residents and faculty in an in-home postnatal breast-feeding education program.

Residents in Family Medicine participate in a one-month rotation dedicated to developing competencies in caring for vulnerable populations and for delivering care in managed care settings. Residents spend time at The Corner (described above) caring for at-risk, low-income adolescents and their children in a community-based setting; making home visits with public health nurses, experiencing nursing home care with a faculty geriatrician, caring for adolescents in a middle school health clinic.

Through the Community Medicine Rotation and standing noon lecture series, residents in Family Medicine experience a core series of seminars and exercises focusing on the clinical care of vulnerable patients and effective practice under managed care.

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